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Bae, Ihin, and Kim: Clinical Analysis of the Pyogenic Osteomyelitis
Original Article

J Korean Orthop Assoc 1975;10(1):37-45.

Published online: 20 September 1975

DOI: https://doi.org/10.4055/jkoa.1975.10.3.37

Clinical Analysis of the Pyogenic Osteomyelitis

Uk Doo Bae, M.D., Joo Choul Ihin, M.D., Ik Dong Kim, M.D.

1Department of Orthopaedic Surgery, Kyungpook National University Hospital, Daegu, Korea.

Copyright © 1975 The Korean Orthopaedic Association

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Clinical analysis of pyogenic osteomyelitis has been made on 124 patients, who had been admitted to the Department of Orthopedic Surgery Kyungpook National University hospital during March 1968 to July 1973. The following results were obstained.
1. The etiologic organism of the majoriy of cases were staphylococcus aureus.
2. As a causative organism, staphylococcus aureus was cultured in 79.5% of the cases.
3. Its incidence was much higher in second decade.
4. Penicillin was resistant to staphylococcus aureus in 91.9% of cases but kanamycin was sensitive in 37.8% of cases.
In 83% of cases treated with saucerization and sensitive antibiotics were arrested.

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Table 1.
Incidence by Year
Year No Stage No. of Cases
Acute Chronic Total
1968 4 9 13
1969 η 7 14
1970 3 8 11
1971 6 17 23
1972 12 28 40
1973 5 18 23
Total 37 87 124
Table 2.
Sex Incidence
Sex No. Stage No. of Cases
Acute Chronic Total
Male 24(19.4) 57(46.0) 81(65.2)
Female 13(10.5) 30(24.0) 43(34.7)
  Total 37(30.0) 87(70.0) 124(100.0)

∗ Figures in parentheses indicate percentage

Table 3.
Age Incidence
Years No. Stage No. of Cases Total
Acute Chronic
Sex Male Female Male Female
Birth— 1 2 — — — 2
  1- 5 2 1 5 — 8
  6-10 — 2 6 4 12
  11-15 9 3 8 2 22
  16-20 3 3 6 9 21
  21-30 — — 11 3 14
  31-40 3 2 4 4 13
  41-50 3 — 12 1 16
  51- 2 2 5 7 16
  Total 24 13 57 30 124
Table 4.
Duration from Onset tó Hospitalization
  Duration No of Case
Less than 1W 6 (4.8)
  1W- 2W 19 (15.3)
  2W- 4W 11 (8. 9)
  İM— 3M 28 (22.6)
  3M— 6M 13 (10.5)
  6M-12M 10 (8.1)
  1Y- 3Y 19 (15.3)
  Over 3Y 18 (14.5)
  Total 124(100. 0)

∗ Figures in parentheses indicate percentage

Table 5.
Predisposing Factor
Factors No. Stage No. of Cases
Acute Chronic Total
Local trauma 7(5.6) 15(12.1) 22(17.7)
Compound fracture 1 (0. 8) 5(4.0) 6(4.8)
Post Op. infection — 3(2.4) 3(2.4)
Other etiology 3(2.4) 1 (0. 8) 4(3- 2)
Unknown 20(16.1) 69(55. 6) 89(71-8)
Total 31 (25. 0) 93(75. 0) 124(100. 0)

∗ Figures in parentheses indicate percentage

Table 6.
Incidence of Draining Sinué
No. of Cases
Yes 49(39)
No 75(61)

∗ Figures in parentheses indicate percentage

Table 7.
No. of Draining Sinus
Number Cases
1 26(53.1)
2 15(30.6)
3 1(2.0)
Over 4 7(14. 3)

∗ Figures in parentheses indicate percentage

Table 8.
Involved Bones
Name of Bones No. of Cases %
Femur 46 28.9
Tibia 32 20.1
Humerus 10 6.3
Ilium 10 6-3
Ischium 6 3-8
Pubis 6 3-8
Calcaneus 6 3.8
Spine 4 2.5
Radius 3 1.9
Ulna 3 1.9
Other bones · 33 20.7
Total 159 100.0

Involving multiple bones: 16

Involving double bones: 18

Involving single bone: 93

Table 9.
Results of Blood Culture
Organism No. of Cases
Staphylococcus (coagulase +) 2
Staphylococcus (coagulase —) 1
Streptococcus —
No growth 15
  Total 18
Table 10.
Results of Pus Culturé
Kinds of Etiological Agents No。of Cases
Staphylococcus (coagulase +) 37
Staphylococcus (coagulase —) 9
Gram (—) bacilli 9
Diplococcus 1
Gram (+) subtillis bacilli 1
No growth 8
Streptococcus 0
  Total 59

No growth; 8 cases

Two Agents were cultured from one patient: 6 cases

Table 11.
Sensitivity Test of Coagulase Positive Staphylococci (37 cases)
Sensitive Moderate Sensitive Resistant
Penicillin 3(8.1) — 34(91.9)
Streptomycin 6(16. 2) 6(16. 2) 25(67. 6)
Kanamycin 14(37.8) 11 (29. 7) 12(32. 4)
Erythromycin 5(13. 5) 2(5.4) 30(81.1)
Vibramycin 7(18. 9) 11(29. 7) 19(51.4)
Orbenin 6(16. 2) 11(29. 7) 20(54-1)
Gentamycin 10(27- 0) 2(5.4) 25(67. 6)
Albamycin 2人 5.4) 2(5.4) 33(89. 2)
Leucomycin 8(21.6) 1(2.7) 28(75.7)
Chloromycetin 7(18.9) —- 30(81.1)
Penbritin 6(16. 2) 4(10. 8) 27(73. 0)
Minocin 5(13. 5) 3(8.1) 29(78.4)

∗ Figures in parentheses indicate percentage

Table 12.
Sensitivity Test of Coagulase Nagative Staphylococci (9 cases)
Sensitive Moderate Sensitive Resistant
Kanamycin — 3(33. 3) 6(66. 7)
Vibramycin — 4(44. 4) 5(55. 6)
Orbenin — 5(55. 6) 4(44. 4)
Gentamycin — 2(22.2) 7(77. 8)
Streptomycin 1(11.1) 1(11.1) 7(77. 8)
Albamycin — 3(33. 3) 6(66.7)
Leucomycin 1(11-1) 3(33- 3) 5(55. 6)
Chloromycetin Kii.i) — 8(88. 9)
Penbritin — 1(11.1) 8(88. 9)
Minocin — 1(11.1) 8(88. 9)
Erythromycin — — 9(100. 0)
Penicillin — — 9(100. 0)

∗ Figures in parentheses indicate percentage

Table 13.
· Duration of Hospitalization
  Duration No. of Cases
Within 1W 21
  1W-2W 25
  2W-4W 44
  1M-2M 17
  2M-3M 5
  3M—6M 4
  6M-1Y 4
  1Y-3Y 3
  Over 3 Y 1
  Total 124
Table 14.
Methods and Results of Treatment
Mothod of Tx, No. & % No. of Cases Followed up No. of Cases Arrested %
Conservative Tx. 21 13 62
Incision and drainage 20 10 50
Closed irrigation 17 13 72
Drilling and/or fenestration 9 6 67
Curettage sequestrectomy primary closure 9 6 67
Curettage sequestrectomy and vaseline gauze packing 26 20 77
Saucerization and vaseling gauze packing 9 7 78
Saucerization and skin graft 3 3 100
Partial or radical resection of bone 5 5 100
Amputation 5 5 100
  Total 124 88 71
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